Pamela Doty, Ph.D., Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation

March 4, 1999

This presentation--given at the Gerontological Society of America, Philadelphia, Pennsylvania on November 1998--was prepared by the Office of Social Services Policy with the U.S. Department of Health and Human Services. The research was funded through contract #HHS-100-96-0001 between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and the MEDSTAT Group. For additional information, you may visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the ASPE Project Officer, Pamela Doty, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. Her e-mail address is: Pamela.Doty@hhs.gov.

The 1994 National Long-Term Care Survey

Funded by the National Institute on Aging

Data collected by Duke University and Bureau of the Census

Earlier surveys: 1982, 1984, 1989

1999 NLTCS planned

The 1994 National Long-Term Care Survey

Disabled Medicare population

Aged 65 and older

Telephone screening to identify disabled (ADLs and IADLs)

In-person interviews of the disabled

Consistency of data elements across surveys

Linked to Medicare claims data

Cross-sectional estimates of the community-dwelling elderly

Ability to examine trends

Number and Percent of Medicare Beneficiaries Using Medicare Home Health Services by Disability Status, 1989 and 1994

Disabled Users

Non-Disabled Users

All Medicare Beneficiary HH Users

1989 Calendar Year

804,089(16.9%)

781,721(3.2%)

1,585,810(5.4%)

1994 Calendar Year

1,362,529 (27.6%)

1,216,945 (4.6%)

2,579,474 (8.2%)

Percent Increase 1989-1994

69%

44%

63%

SOURCE: 1989 and 1994 National Long-Term Care Surveys and HCFA Administrative Claims.NOTE: Percentages in parentheses represent proportion of group using Medicare home health services, i.e., 16.9% of disabled elders used home health services in 1989.Disability is defined as 1+/6 chronic ADLs or 1+/9 chronic IADLs (use of assistive devices not included in the definition of disability.)

Changes in Medicare Home Health Use Between 1989 and 1994, By Disability Status

1989

1994

Percent Increase: 1989-1994

Mean (Median) Visits Per User in Calendar Year

Disabled

40.3 (21)

106.3 (52)

164% (148%)

Non-Disabled

21.7 (11)

34.5 (20)

59% (82%)

Total

31.1 (15)

72.5 (32)

133% (113%)

Mean (Median) Visits Per Episode in Calendar Year

Disabled

32.9 (16)

96.2 (44)

192% (175%)

Non-Disabled

19.6 (11)

32.4 (18)

65% (63%)

Total

26.6 (13)

66.8 (27)

151% (108%)

Mean (Median) Visits Per Episode in Calendar Year, Extended

Disabled

69.6 (24)

273.1 (72)

292% (200%)

Non-Disabled

28.4 (12)

59.0 (25)

107% (108%)

Total

50.3 (17)

154.9 (49)

208% (188%)

SOURCE: 1989 and 1994 National Long-Term Care Surveys and HCFA Administrative Claims. The parameters of a home health episode are defined by a minimum of a "clean" period of 60 days both before the first home health claim and 60 days following the last home health claim. In this table, some episodes are "extended" to include HH utilization outside the calendar year but associated with episodes in force at the beginning and/or end of calendar year.Definition of disability: 1+ chronic ADLs/6 or chronic incontinence or 1+ chronic IADLs/9; assistive devices not included in the definition of disability.

Changes in Medicare Home Health Expenditures Between 1989 and 1994, By Disability Status

SOURCE: 1989 and 1994 National Long-Term Care Surveys and HCFA Administrative Claims. The parameters of a home health episode are defined by a minimum of a "clean" period of 60 days both before the first home health claim and 60 days following the last home health claim. In this table, some episodes are "extended" to include HH utilization outside the calendar year but associated with episodes in force at the beginning and/or end of calendar year. Definition of disability: 1+ chronic ADLs/6 or chronic incontinence or 1+ chronic IADLs/9; assistive devices not included in the definition of disability.

Contribution of the Disabled and Non-Disabled Elderly Populations to Increases in Medicare Home Health Between 1989 and 1994 Calendar Years

Type of Increase 1989-1994

Increase Accounted for by Disabled

Increase Accounted for by Non-Disabled

63% Increase in Beneficiaries Using Home Health Services

56.20%

43.80%

50% Increase in Total Number of Home Health Episodes

55.31%

44.69%

275% Increase in Total Number of Home Health Visits

82.00%

18.00%

338% Increase in Total Home Health Expenditures

79.43%

20.56%

Characteristics of Disabled HH Users and Non-Users, 1994

Characteristic

HH Users

HH Non-Users

P-Value

Mean Age

79.9

77.7

< .05

Percent Female

72.3

68.3

< .05

Percent White

84.0

85.8

NS

Percent Married

35.9

43.8

< .05

Mean ADLs/5

1.81

1.0

< .05

Mean IADLs/9

4.9

3.2

< .05

Percent Cognitively Impaired

24.7

16.4

< .05

Percent Incontinent

16.9

7.0

< .05

Percent Indiv/Spouse Income $15,000+

34.9

44.4

< .05

Percent Lives with Others

66.2

72.8

< .05

Percent of Medicaid/SSI

23.0

17.7

< .05

Characteristics of Disabled HH Users and Non-Users, 1994, Continued

Characteristic

HH Users

HH Non-Users

P-Value

Percent with Diabetes

24.0

17.5

< .05

Percent with Cancer

10.1

8.1

NS

Percent Paralyzed

11.5

7.4

< .05

Percent Suffered Stroke

14.1

7.9

< .05

Percent Suffered Heart Attack

5.6

4.5

NS

Mean Number Prescription Medications

3.9

3.0

< .05

Mean Hours of Care Per Week From Informal Sources

32.3

20.3

< .05

Mean Hours of Care Per Week From Formal Sources

11.6

4.7

< .05

SOURCE: 1994 National Long-Term Care Surveys and HCFA Administrative Claims. NOTE: Disability defined as 1+ chronic ADL/6 or 1+ chronic IADL/9 or evidence of incontinence. Use of an assistive device without the need for personal assistance is not considered sufficient evidence of disability.

Medicare Home Health IPS Simulation

Identify Characteristics of Beneficiaries Who Would Exceed the Per Beneficiary Cost Cap

Characteristics of Disabled* Medicare Beneficiaries Who Would Have Exceeded the Home Health IPS Limit

Less Than or Equal to Cap (N=406)

Exceeds Cap (N=402)

Mean Age

80.02

79.95

Percent Female

70.88

72.09

Percent White**

89.22

83.04

Percent Married

37.47

38.06

Mean # of ADLs**

1.45

2.58

Mean # of IADLs**

4.43

6.16

Percent Cognitively Impaired**

18.32

31.14

Percent Others Manage Incontinence**

11.36

26.97

Percent with $15,000+ Indiv/Spouse Income**

41.34

31.86

Percent Lives with Others**

63.55

72.28

Percent on Medicaid/SSI

22.13

22.48

Percent with Diabetes

22.33

26.03

Percent with Cancer

10.44

10.75

Percent Paralyzed**

8.48

15.90

Percent Suffered a Stroke**

14.21

19.77

Percent Suffered a Heart Attack

7.91

7.91

SOURCE: 1994 National Long-Term Care Surveys and HCFA Administrative Claims. * One or more ADLs out of five or one or more IADLs out of nine; chronicity included, assistive device not included. ** p<0.05

Characteristics of Disabled* Medicare Beneficiaries Who Would Have Exceeded the Home Health IPS Limit, Continued

Less Than or Equal to Cap (N=406)

Exceeds Cap (N=402)

Mean # of Prescription Medicines**

3.74

4.37

Mean # Hours of Care from Informal Sources**

27.77

40.97

Mean # Hours of Care from Formal Sources**

10.34

17.93

Percent Used Inpatient Services

63.40

61.25

Percent Used SNF Services**

11.10

16.72

HCBS in State:- Percent High- Percent Average- Percent Low

20.1326.5153.35

19.3227.6653.03

Mean Percent Proprietary HH Agency in State**

43.81

48.85

Mean # of NH Beds/1000 in State**

53.14

56.45

SOURCE: 1994 National Long-Term Care Surveys and HCFA Administrative Claims. * One or more ADLs out of five or one or more IADLs out of nine; chronicity included, assistive device not included. ** p<0.05

Percent of Medicare Home Health Users Exceeding the IPS Per Beneficiary Limit, by Disability Status

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